The SDP National Healthcare Plan: Facts & figures

August 17, 2012
Singapore Democrats

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Dr Tan Lip Hong

The SDP National Healthcare Plan (NHP) is a government-run national health insurance scheme in which every Singapore resident contributes an insurance premium each year. In return, each resident need only pay a co-payment amount each time he or she visits a doctor.



Annual Premium

Every Singapore citizen or Permanent Resident (PR) will pay an Annual Premium to be covered under this national health insurance scheme. This amount is about $600 a year, and will be deducted from the person’s CPF account. PRs will pay slightly more, and children and the poor will pay less. The very poor, those without income, and the unemployed will be fully subsidised.

Adults

Singaporeans

Permanent Residents

– Single: Income >$1500

– Married: Total family incomea >$3500

$600

$700

– Single: Income $1500 – >$800

– Married: Total family income $3500 –

>$2000

– Full-time Tertiary Students: Parents’

combined income >$3500

$300

$400

– On Unemployment or Social Welfare

benefits

– Single: Income ≤$800

– Married: Total family incomea ≤$2000

– Full-time Tertiary Students: Parents’

combined income ≤$3500

Full subsidy

Full subsidy

Minors

Singaporeans

Permanent Residents

Parents’ combined income >$4000

$300

$400

Parents’ combined income $4000 – >$3000

$150

$200

Parents’ combined income ≤$3000c

Full subsidy

Full subsidy

For a family of 4, the amount payable is shown below (compared to current Medisave scheme):

Total family income

National Healthcare Plan

Current Medisave

Annual Contribution

Monthly Contribution

% of Earnings

Annual Contribution

Monthly Contribution

% of Earnings

>$4000

$1800

$150

≤3.750%

>$3360

>$280

7% – 9.5%

$4000 – >$3500

$1500

$125

≤3.571%

>$2940

>$245

7% – 9.5%

$3500 – >$3000

$900

$75

≤2.500%

>$2520

>$210

7% – 9.5%

$3000 – >$2000

$600

$50

≤2.500%

>$1680

>$140

7% – 9.5%

≤$2000

$0

$0

0.000%

≤$1680

≤$140

7% – 9.5%

(The amounts listed are for Singaporeans. PRs will pay a slightly higher rate as published.)


Co-payment

To encourage responsible use of healthcare services, a co-payment amount will have to be paid each time a person visits a doctor. This co-payment amount is 10% of total bill size in most cases. For minor short-term illnesses like food poisoning or coughs and colds, a flat subsidy of $10 is given for each visit.

This co-payment applies to visits to the polyclinic, GPs, specialists, and all public and private hospitals. For private healthcare, the subsidised amount is based on the subsidy level for use of public healthcare services. For example, if your hospital bill comes to $5,000, you pay a co-payment of $500.

Co-payment amount

Acute self-limiting illnesses at Primary and Secondary Care Level (Including at A&E)

$10 subsidy given per visit

All other illnesses at Primary and Secondary Care Level including all procedures & investigations

10% of bill

All illnesses at Tertiary Care Level

10% of bill


Co-payment Capping

Despite a co-payment of 10 percent, there may be instances when the total bill size may be so large that the co-payment amount becomes unmanageable. For example, a hospital bill can approach $100,000. This would mean a co-payment of $10,000, a very substantial amount.

For this reason, an annual cap in co-payment amount is proposed. This amount is $2,000 for the normal scheme, and $500 for the poorer segments of the population. These amounts correspond to a total bill size of $20,000 and $5,000.

Capping per year

All chronic illnesses/treatment

$2000 / $500

Capping amounts for chronic illnesses requiring expensive continuous/recurrent treatment.

For chronic illnesses that require expensive continuous or recurrent treatment, for example, dialysis treatment, chemo or radiotherapy, stroke treatment and rehabilitation, even the $2000 per year cap can represent a significant outlay over time.

For these illnesses, we propose a cap of $2,000 in the first year of treatment, $1,000 in the second, and $500 thereafter. This amount only refers to the particular illness/treatment. For all other illnesses, the total cap of $2,000 remains.

Capping per year

First year of treatment

$2000

Second year of treatment

$1000

Third and subsequent years of treatment

$500

(For particular illness and treatment. Overall cap remains.)

Is the SDP NHP Scheme Feasible?

Do the sums work out under the NHP? In other words, where are the funds going to come from and are they sustainable in the long run?

In 2010, the Total Healthcare Expenditure (THE) in Singapore was $12 billion. Of this, the Government Healthcare Expenditure (GHE) was $4 billion (33%), and the Private Healthcare Expenditure (PTE) was $8 billion (66%).It is estimated that by then, the total Healthcare Expenditure (THE) would reach $14.7 billion.

Under the SDP NHP, the annual premiums paid by residents is estimated to come to a total of $1.3 billion.

The total 10 percent co-payment amount is estimated to come to a total of $ 600 million.

In additional, additional private healthcare spending by residents is estimated to reach $2.3 billion.

This means that total Private Healthcare Expenditure (PHE) under the SDP Plan would be about $4.2 billion.

We propose that the Government Healthcare Expenditure (GHE) be raised to $10.5 billion. This would include at least $1.5 billion in infra-structure and manpower expansion programmes.

This would mean a GHE:PHE ratio of 71%:29%.

Total Healthcare Expenditure (THE)

Government Healthcare Expenditure (GHE)

Private Healthcare Expenditure (PHE)

2010

$12 billion

$4 billion (33%)

$8 billion (66%)

2014 (Estimated)

$14.7 billion

$10.5 billion (71%)

$4.2 billion (29%)


Summary of Payment Schemes under NHP

The Table below summarises the details of all the payment schemes under the SDP’s NHP.


Adults

Scheme

Annual Contribution

Copayment

Annual Cap

Singaporean

PR

Acute Illness

Chronic Illness

Chronic Illness

Chronic Illnesses requiring Expensive Long Term Treatmentc

– Single: Income >$1500

– Married: Total family income >$3500

Normal

$600

$700

$10 Subsidy per visit

10%

$2000

$2000 1st Year.

$1000 2nd Year.

$500 subsequently.

– Single: Income $1500 – >$800

– Married: Total family income $3500 –

>$2000

– Full-time Tertiary Students: Parents’

combined income >$3500

APS

$300

$400

$20 Subsidyper visit

10%

$500

$500 1st Year.

Full subsidy subsequently.

– On Unemploymenta or Social Welfarea

benefits

– Single: Income ≤$800b

– Married: Total family income ≤$2000b

– Full-time Tertiary Students: Parents’

combined income ≤$3500b

FS

Full subsidy

Full subsidy

Full Subsidy

Full Subsidy

Full Subsidy

Full Subsidy

Minors

Scheme

Annual Contribution

Copayment

Annual Cap

Singaporean

PR

Acute Illness

Chronic Illness

Chronic Illness

Chronic Illnesses requiring Expensive Long Term Treatmentc

Parents’ combined income >$4000

APS

$300

$400

$20 Subsidy

per visit

10%

$500

$500 1st Yr.

Full subsidy subsequently.

Parents’ combined income $4000 – >$3000

$150

$200

Parents’ combined income ≤$3000b

FS

Full subsidy

Full subsidy

Full Subsidy

Full Subsidy

Full Subsidy

Full Subsidy

a. Under proposed SDP benefit schemes.
b. Subjected to restrictions under SDP benefit schemes and the FS scheme.
c. For particular illness and treatment. Overall cap remains.


Dr Tan Lip Hong is a member of SDP’s Healthcare Advisory Panel.